Simplify Your Practice: Be The Best At One Thing

Be the best at one thing. So I want to ask, I'm going to start there. What's your one thing? Anybody thought of the one thing that you want to be the best at? Okay, maybe here's another question. If the one thing isn't coming right to you. Oh, we got one here. Here we go. Thank you.

So there's the low-hanging fruit one thing, and then there's the ultimate goal one thing for me. And I can articulate both of them easily. I've been cash-based for 30 years. I was a very early adopter. Board certified in emergency medicine, quit that because of exactly what you talk about, Matt, about the trauma of seeing what insurance was doing, what Big Pharma was doing, and then losing my best friend in a shootout in the ER after she and I were at a date the night before. I wasn't working on Easter Sunday, she was. 7 people shot, 2 people died, and she was one of them at a hospital in San Diego.

Ugh.

1995. So we all get shaped by our personal traumas. And being an ER doc and cracking chests and holding my finger in the gunshot wound and the chest surgeon not coming in because of the collapse of the economics of the trauma system in San Diego, and then the guy waking up while I've got my finger in the hole of his heart and doing open-heart massage, you know, and recognizing that this was the second time I'd cracked his chest in 6 weeks. He's just a kid trying to get out of his economic slavery living in the inner city of San Diego, right?

Yeah.

So I studied a lot in consciousness medicine and everything from basic science of studying spiritual healers and Faraday boxes to traveling around the world and working with shamans, working with indigenous healers, speaking to executives at Kaiser, speaking— and what's the true economy of healthcare?

Mm-hmm.

And learning human physiology, not just from Western anatomy physiology, but studying Ayurveda, becoming certified in traditional Chinese medicine and acupuncture, bringing all that all together and doing the first cash-based practice of medicine in the state of Hawaii. So my short-term regenerative medicine niche is knees. It's easy, it works.

Yep.

We can, we can train other people in scale and we can make a great impact. My long-term goal is actually, because it has to do with internal medicine, it has to do with progression of human physiology over a lifespan, it has to do with the politics of medicine and the diseases of our society and the loss of reproductive Health for women in our current political climate that is being imperialized all over the world. My long-term goal is inflammatory pelvic disease in both men and women as they age.

Yes, beautiful. And you can use, by the way, if you have the low-hanging fruit of the knees, it's perfectly fine to go after that, to use that to fund the future. We do that all the time in business.

Okay?

Sometimes you have to have a bridge like that. Teva and I talk about it all the time. I mean, Teva and I partner on stuff all the time, right? He's one of my closest friends, you know, and, you know, we talk about this stuff all the time and we're frickin' probably out on the road God knows how many days a year with each other.

A lot.

A lot. But that's— this is one of the things we do is like, okay, I can do this short term to be able to fund the next, the next step.

Yeah.

And that's perfectly cool to do that. So, good for you. Awesome.

Absolutely. Absolutely. Anyone else? One thing. Okay, so let's go the other way. What's one thing that you know you need to stop doing?

Yeah.

Maybe you can't focus on the one thing you should do, but what do you know? Right here.

Go. I guess rather than an answer to your question, I think I have a question.

Sure.

For example, so I'm a sports orthopedist, and we're already subspecialized. So it's kind of hard. I do shoulders, knees, hip, ankle scopes. It's how I trained. And so should I be thinking about focusing on shoulder, which is probably the majority of my— what I like the most? Or is that where I set my beachhead, so to speak? Or am I already subspecialized enough?

Do you love shoulders?

Yes.

If I could tell you that you could only work on shoulders for the rest of your life, would you be jazzed about that? When I say rest of your life, let's say the next 5, 10 years.

So I like the variety of what I do, so that's, you know, that's where it's hard.

Now, I'm not saying you're not going to do—

choose one of all those things, it would be shoulder.

Okay.

Yeah.

And I'm not saying you wouldn't do a knee if it came in, right? I— if I want you to be known as the best shoulder guy, yeah, then yes. Okay, then do that.

There it is.

You can't— I want— this is where people get really tripped up. They're like, but wait, I can't do a foot? Yeah, you can do a foot, because guess what's gonna happen?

Let's not get that far.

What's that?

Let's not get so far.

Yeah, okay. Sorry, I didn't mean to insult you. Okay, small little bones. Yeah, I mean, Arianna, what do you do mostly? What's your— what's your big— what's your thing that you treat the most of?

My favorite thing is shoulders.

Okay. Yeah.

Yeah.

But you still do knees, right?

Yep.

Still do backs?

Yep.

Yep.

Feet, hands, whatever.

Elbows.

Right, elbows.

Only on vacation though.

Yeah, on the occasional crazy one. But to be known as the best shoulder person, you'll be amazed, it will bring everybody else. Well, like, well, if you can do a shoulder, can't you do my knee? Okay, that's what we're talking about here. I'm not saying to never do another knee again.

So let me give you a real quick story on that. So I did a presentation about 8 weeks ago at our mastermind, and I get up and I say, hey, I only work with doctors. I do marketing for doctors. A woman comes up to me afterwards and she says, I must work with you. I love you. I want to be your client. I said, okay, great. What do you do? I publish books. They'll come.

Yeah, they'll come. People are like, when you say you're the best at something, You know, the fascinating thing about— we work like our core customers are orthopedic surgeons, pain management. So that's the regenerative space traditionally, right? And then functional medicine, which is like the whole functional medicine anti-aging space. They're like everything, right? There's not one specialty. I have urologists, anesthesiologists, family docs. Like, I have it all. Okay. Those are our two things. I got a call the other day from somebody. I don't think I told you this. He's like, yeah, I have a big network of dentists. Can you work with dentists? I'm like, I hate going to the dentist.

Me too.

He goes, I read your book. He goes, dentists need what you have to say. I'm like, I don't work with dentists, but thank you. Okay, I have enough to say grace over. But that's what I mean. That's what he said. Like, you'll get people that'll come over all the time. Yes, Sam, you got something?

Sam Carruthers.

You're talking about the one thing. But how do you put in your office the spillover stuff, the other stuff that your existing patients may like, even if that's not your leading thing?

You know, that's always a big question, right? How do I deal with the existing patients? And over time, you just kind of winnow that out. You have to go through a process. So 80/20 is dual, right? This is what Arianna did. 80/20 is dual. Most people focus on the 20% that drives the 80%. What I want you to do is I want you to identify the 20% The bottom 20%. And what are the bottom 20% of the things that are eating up a big chunk of your time that don't make you any money? Now, this is always a conundrum with doctors, right? Well, but I want to serve my community. Nobody else in my community is doing it just like me. Look, we get that and we understand that, but if I'm talking about this from a pure business standpoint, that is getting in the way. That's the resistance that's getting in the way for you to actually go to your calling.

Yeah.

So you have to cut out the bottom 20%. You have to be ruthless about it.

You know, put it another way. Everybody's seen the movie Titanic? Everybody familiar with the Titanic, right?

That's the one that sinks, right?

It does sink.

Okay.

At the end.

Okay.

Not at the beginning. That's a different movie. Anyway, how many of you would have liked to help the people on the Titanic if you could? Like, that's a natural human thing, right? Everyone says that. The challenge is most of us try to help the people on the Titanic by pulling up in a rowboat. And a frickin' rowboat will do nothing. You need a ship bigger than the Titanic. So when you're trying to help everyone and your ship is sinking, you're going to sink faster.

Yeah.

Yep.

You have any comment on this, Arianna? Because I know you do.

Yeah. So what do you do with all the people? You limit access.

Yeah.

Not illegally. But what I've done is for my Medicare patients, I only see Medicare patients on Tuesdays. You cannot schedule a Medicare patient on a Wednesday. I'm happy to see you. We're booked out for 4 months. I'm so sorry, but I can schedule you. But you're not going to take up the spots that I see my cash patients in because I block— I block that. That's my block time. For my cash-paying patients, I want to be able to adequately respond in an appropriate time frame and schedule them faster.

Well, you went through this with surgery, didn't you? Because you were doing surgery 8 days a week. God, it feels like— I know, just kidding. 8 days a month. I always like to say 8 days a week. Yeah, right. And that was a— when you knew— tell everybody, because you knew you're making $750 a surgery or whatever, $1,000 a surgery.

Yeah, you got to do a lot of them.

And you gotta do a lot of them, you're sitting there and you would say every day, like, what would you say to yourself every day when you're going to do surgery?

This is the worst financial decision I will make all week.

Tell me, tell us more about that.

Yeah, so every week I would be doing surgery, I'm like, oh my gosh, I am losing money today, I am losing money today, I could be making 3 times more in my office, I should be doing PRP or BMC or Otopose in my office I should not be doing this, pulling my hair out, trying to get the room to turn over, trying to like— it's like, you know, herding cats and like pushing rope to try to make it happen. And it's the worst decision. So what did I do? I decided to go down on the days of surgery that we do. So currently I do 2 days of surgery a month. And you know what I do those other days that used to be surgery days? Those are my procedure days for regenerative medicine. What's the money difference? A lot. Like 4 times. So I make 4 times the amount of money in my procedure days than I made in my operative days.

And you're getting amazing patient outcomes.

Phenomenal. They're so much happier.

Saving a lot of people from surgery and the suffering of surgery.

Absolutely. And that's what I've— what I've found is my surgery patients are good. How you doing?

Good.

How's your shoulder? Good.

Good.

Okay. I see my regenerative patients. I'm like, how's your shoulder? Oh my God, it's so amazing. So if you want to go from good to great for your patients, orthobiologics and injection-based therapies is the way to get there. They're happier. Yeah, they're just happier. I don't know. It's it's shocking, and I'm like I keep going in afterwards. I'm like, so how you doing? They're like blah blah blah blah blah, and then and I got an appointment for my brother and my you know my husband. I made an appointment for him to get the same thing. They have to get it done. Like amen. Yes, thank you.

That's awesome. That's absolutely awesome.